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General NPI Number Information
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NPI Number | 1932610664
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Entity Type | Organization
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Legal Business Name | DAVID NISENBOYM, DDS, INC.
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Dates
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Enumeration Date | 10/20/2017
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Last Update Date | 10/20/2017
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Provider Practice Location Address
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Address Line | 2439 OCEAN AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94127-2606
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Country | US
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Telephone | 415-334-1737
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Fax |
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Provider Business Mailing Address
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Address Line | 1730 SACRAMENTO ST APT 10
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City | SAN FRANCISCO
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State | CA
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Zip | 94109-3671
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Country | US
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Telephone | 916-704-0974
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DAVID NISENBOYM
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Credential | DDS
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Telephone | 916-704-0974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 63382
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License Number State | CA
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